Health care law changes

Join us at 11 a.m. CT (12 p.m. ET/9 a.m. PT) on Thursday, Feb. 17, for an hour-long chat about benefits in the health care law. The chat will be moderated by Chicago Tribune health reporter Bruce Japsen and panelist Dr. Cecil Wilson. Some topics included in the chat will be about changes doctors and medical care providers think need to be made so the legislation will work better for consumers.

Millions of Americans this year have new benefits under the health care overhaul law signed last year by President Barack Obama, but he is open to certain changes as long as they improve the law and don't take away certain benefits.

Dr. Cecil Wilson, President of the American Medical Association, is an internist from Winter Park, Fla., and the 165th President of the AMA, which is the nation's largest doctor group. The AMA represents nearly one-quarter of a million doctors in the U.S., and the AMA, for one, has long advocated for medical liability reform. President Obama said he would be willing to work with newly elected Republicans in Congress on such legislation.

If you are unable to make the chat, or would like to send your question in advance, e-mail Bruce Japsen at bjapsen@tribune.com.

Welcome to our chat today on potential upcoming changes to the health care law. I'm Bruce Japsen, health care reporter for the Chicago Tribune and Tribune Newspapers. Joining me today is Dr. Cecil Wilson, president of the American Medical Association. Dr. Wilson is also an internist from Winter Park, Fla.

So, Dr. Wilson, we know that many health benefits have already begun to become available to millions of Americans yet the political winds are such in Washington that there may be changes to the law, potentially adding more benefits and potentially taking things away.

What do you and the AMA see as urgently needed changes that could benefit the U.S. consumer, patients and doctors that could be added to the legislation?

Thursday February 17, 2011 10:59 Bruce Japsen

11:00

Cecil B. Wilson, M.D.:

The key issues in the health reform law that deserve attention include protecting access to physicians with a permanent fix for the Medicare payment formula, comprehensive medical liability reform, and ensuring physician participation in new models of care, such as accountable care organizations.

Congress made important changes to our nation’s health care system that will help patients and the physicians who care for them by extending health coverage to tens of millions of uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research.

But more work needs to be done. 2011 will be an important year in health care, and the AMA is working actively with Congress, the administration and federal agencies, on a variety of issues critical to reducing health care costs, ensuring patients' access to physician care, and supporting innovations that will move our health system into the future.

Thursday February 17, 2011 11:00 Cecil B. Wilson, M.D.

11:02

[Comment From ChrisChris: ]

What is an Accountable Care Organization

Thursday February 17, 2011 11:02 Chris

11:06

Cecil B. Wilson, M.D.:

The idea of an Accountable Care Organization (ACO) is a group of health professionals, led by physicians, who agree to take responsibility for a group of patients to help control the cost of medical care while improving the quality of care. This is done through improvements including increased coordination of care, providing the right care at the right time in the right setting, increasing preventive care and wellness, and following scientific guidelines.

Thursday February 17, 2011 11:06 Cecil B. Wilson, M.D.

11:09

[Comment From GuestGuest: ]

What are the most critical wellness services that will become available?

Thursday February 17, 2011 11:09 Guest

11:10

Cecil B. Wilson, M.D.:

The Affordable care Act recognized that we as a society need to make wellness and preventive care a priority. It provides a mechanism to look at ways we can make that happen by focusing on those important areas that we know make a difference, such as obesity, cigarette smoking, alcohol abuse, sedentary lifestyle, and immunizations.

Thursday February 17, 2011 11:10 Cecil B. Wilson, M.D.

11:10

[Comment From LeeLee: ]

Who is going to act on ensuring access to physicians for the people who make too much to have governmental assistance and too little to afford health insurance or self payments?

Thursday February 17, 2011 11:10 Lee

11:11

Bruce Japsen:

The health care law will expand medical care coverage to 30 million Americans by 2014. About half of these people will become eligible for state run Medicaid health insurance programs and the other half will get subsidies from the government to buy private coverage from state run exchanges. Thus, the middle class who now are unable to afford coverage and make too much money to qualify for Medicaid under the existing system, would now be able to afford coverage.

Thursday February 17, 2011 11:11 Bruce Japsen

11:12

[Comment From MerryMerry: ]

Aren't most ACO's going to be run by hospital systems and PHOs that already influence where/when a patient gets care?

Thursday February 17, 2011 11:12 Merry

11:14

Cecil B. Wilson, M.D.:

The reality is that the structure and form of ACOs has not been established. The Affordable Care Act (ACA) provides that there will be not one, but multiple forms. The AMA believes that this is important. One structure, such as a hospital-physician structure, will not work for different areas of the country and settings, and that it would decrease competition and would not serve the country well. Given the size, variety, geography and socioeconomic status of our citizens, one size does not fit all.

Thursday February 17, 2011 11:14 Cecil B. Wilson, M.D.

11:14

[Comment From Virginia BishopVirginia Bishop: ]

Are there any provisions in the PPACA healthcare reform law that the AMA would prefer to be amended, or eliminated?

Thursday February 17, 2011 11:14 Virginia Bishop

11:22

Now that certain health benefits are available under the law and the new Congress has discussed potential changes, how should Congress act? Make no changes. Leave the bill alone.

( 42% )

Make some changes but continue covering unisured.

( 50% )

Toss out the bill and start over.

( 8% )

Thursday February 17, 2011 11:22

11:25

Cecil B. Wilson, M.D.:

As indicated previously, reform of the Medicare physician payment structure and medical liability reform are priority issues that are not addressed in the ACA. One of the major provisions of the ACA we would like to see changed is the Independent Payment Advisory Board (IPAB). Our concern is that ,as presently constituted, this board could put physicians in a double jeopardy situation of having two payment cuts in one year. The board also has very little oversight from an elected body - Congress. Its authority is primarily directed toward cutting Medicare expenditures. This does not take into account the reality that there may be some years where advances in new technology or a pandemic, such as the recent H1N1 pandemic, could mean increased payments by Medicare would be appropriate.

An additional item in the bill is the IRS 1099 reporting requirement, which we oppose because it will create an unnecessary paperwork burden for physician practices and other small businesses. The Senate has voted to repeal that requirement, and we look forward to the House following suit.

Thursday February 17, 2011 11:25 Cecil B. Wilson, M.D.

11:27

Bruce Japsen:

Dr. Wilson, a lot of people hear about the "doc fix" the AMA and doctor groups want from Congress that will enhance Medicare payments that have faced large cuts. How have the proposed cuts threatened patient care?

Thursday February 17, 2011 11:27 Bruce Japsen

11:28

Cecil B. Wilson, M.D.:

It is important that seniors know that the changes in the ACA do not in any way decrease benefits to Medicare patients. In fact, there are improvements in the ACA, such as wellness and prevention services without co-payments, the addition of an annual wellness exam, and closing the so-called doughnut hole of Part D Medicare drug benefits.

Thursday February 17, 2011 11:28 Cecil B. Wilson, M.D.

11:31

Cecil B. Wilson, M.D.:

The importance of fixing Medicare physician payments is to ensure that physicians can continue to see Medicare patients. The reality is that current payments are the same as they were in 2002, and do not cover the cost of providing care. As a result, many physicians are having to make the gut wrenching choice of not continuing to see all Medicare patients. Fixing this problem is critical to the continued viability of the Medicare program. And, much of the success of the ACA will depend on a stable Medicare program.

Thursday February 17, 2011 11:31 Cecil B. Wilson, M.D.

11:31

Thursday February 17, 2011 11:31

11:33

Bruce Japsen:

Dr. Wilson, the Medicare payment fix that President Obama has included into the budget will add tens of billions of dollars in spending at a time Congress is looking for ways to cut. How is this good, economically, for the country.

Thursday February 17, 2011 11:33 Bruce Japsen

11:35

Cecil B. Wilson, M.D.:

We understand the importance of the financial situation we're in as a country, the challenges of the debt, but it is penny wise and pound foolish to allow this imortant program for seniors to be destroyed and adversely impact the lives and health of those for whom this program was established, and into which they have made payments throughout their working careers.

Thursday February 17, 2011 11:35 Cecil B. Wilson, M.D.

11:36

[Comment From MerryMerry: ]

Don't other isurance companies model their payments on the Medicare Fee Schedule? So we're talking much bigger than Medicare, right?

Thursday February 17, 2011 11:36 Merry

11:40

Bruce Japsen:

Under health care reform, insurance companies are looking at all sorts of ways that will result in changes of how they pay doctors and hospitals. They say they are not trying to cut costs but in reality they are soon going to be required to spend 80 percent of their premium dollars on medical care. Thus, they are looking at all sorts of ways to achieve these mandates.

Thursday February 17, 2011 11:40 Bruce Japsen

11:40

[Comment From Virginia BishopVirginia Bishop: ]

Could you explain in more detail the concern you expressed about the IPAB as it is presently constituted, and how double jeopardy could potentially occur to affect payments twice in a year? Is there any oversight to this Board? Who is on it?

Thursday February 17, 2011 11:40 Virginia Bishop

11:43

Cecil B. Wilson, M.D.:

The reference to double jeopardy is that physicians already face cuts every year based on the Medicare physician payment formula, called the Sustainable Growth Rate. The IPAB would establish an additional formula on top of the current one, which could mean that in any one year, there could be cuts to physicians based on both of the formulas. The IPAB would be an appointed independent body. It has not been appointed yet. The only oversight on its actions would be Congress' ability to totally reject its recommendations in much the same way as the military base closing commission is established.

Thursday February 17, 2011 11:43 Cecil B. Wilson, M.D.

11:48

Bruce Japsen:

Dr. Wilson, there has been a lot of discussion about adding medical liability reform to the health law. Most people know the AMA position as capping non-economic damages. When a patient is truly harmed, many in Congress and across the country, don't think there should be a cap. How could the AMA work to come to an agreement most could live with?

Thursday February 17, 2011 11:48 Bruce Japsen

11:53

Cecil B. Wilson, M.D.:

The reality is that the current medical liability system does not work well. It does not provide help in a timely or effective manner to those who have been injured, and it subjects physicians to the threat of going to court frequently because of nonmeritorious suits. This system needs to be fixed.

Medical liability reform is critical as every American pays the price for high medical liability costs.

The AMA has always held that patients who have been injured through negligence should be compensated fairly. If there's been a wrong, we want it made right.

Unfortunately, the medical liability system has failed patients because it invites abuse and inefficiency. The system is choked with medical liability claims that lack merit, as nearly two-thirds of claims are typically dropped or dismissed. According to a Harvard study, 40 percent of claims lack any evidence of either a medical error or patient injury.

We know from a 35 year experience that caps on noneconomic damages, like those enacted in California, do work in holding down costs without decreasing access to the courts for patients.

The AMA supports proven reforms like those in the bi-partisan HEALTH Act (HR 5) that allow unlimited payment for economic damages, while capping non-economic damages at a quarter of a million dollars.

Thursday February 17, 2011 11:53 Cecil B. Wilson, M.D.

11:55

Should patients who are harmed by medical malpractice have the non-economic damages be capped at a certain threshold? In California, for example, such damages are capped at $250,000 per claim?Yes

( 67% )

No

( 33% )

Thursday February 17, 2011 11:55

12:00

Bruce Japsen:

Thank you, Dr. Cecil Wilson, president of the American Medical Association who has been our guest. And also thanks to those of you who joined us for our chat today on possible changes to the health care law.

Please tune in for next Tuesday's chat with my colleagues from Tribune Newspapers who will be discussing alternative medicine at noon Central Time.